Telehealth Interventions to Support Self-Management of Chronic Conditions
Improving the patient’s ability to self-manage their chronic disease can improve quality of care and outcomes, as well as decreasing the costs of care
Self-management support interventions can be part of a disease management program, and may be delivered via telehealth
The PRISMS taxonomy identified several components of self-management support.
This article demonstrate ways in which these components could be reconstructed for telehealth delivery
May 20, 2020 — Interventions for self-management support can help address the prevalence of chronic conditions. These interventions could be implemented as a core component of any (chronic) disease management program — including those delivered via telehealth.
The CDC defines chronic conditions as those that last 1 year or more and require ongoing treatment and/or limit daily activities. Chronic conditions include Alzheimer’s disease, diabetes, asthma, heart disease, COPD, HIV, cancer, and obesity (1, 2). Chronic conditions cost the U.S. about 3.5 trillion dollars in annual health costs (1).
The average age of the US population continues to increase — and with it — the number of chronic conditions. At least half of the adult population of the US have a chronic disease — but I’m being cautious (the numbers are probably higher).
Self-management is defined as “the tasks that individuals must undertake to live with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions” — US Institute of Medicine (3). Self-management is not the sole responsibility of the person living with a chronic condition. It requires collaboration with healthcare providers to deliver on-going support for the patients and their caregivers (4).
Telehealth has been proposed as one strategy by which self-management support may be implemented; and while telehealth-mediated self-management is not consistently superior to usual care, it is considered a safe option for delivery of self management support, particularly in chronic conditions such as heart failure and type 2 diabetes (5).
The PRISMS taxonomy identified 14 separate components that might be used to support patient self-management across a range of chronic conditions (4). These components could be reconstructed into six intervention categories and implemented via telehealth (5):
Patient education
Remote monitoring with feedback and action plans
Telehealth-facilitated clinical follow up
Adherence and compliance support
Psychological support
Lifestyle interventions
Telehealth Intervention for Patient Education
The goal of this telehealth intervention is to educate people with chronic conditions on their disease and on the general principles of managing it. Topics may include basic mechanisms of disease, types of medications and how these work, the expected prognosis of the condition, common psychosocial issues related to the condition. These interventions can also provide patients with information on financial resources, sources for social and peer support, non-profit organizations, etc… Another benefit of the intervention is the increase in the patient’s self-efficacy towards the use of technology, which would further help the patient benefit from the intervention.
Telehealth Intervention for Remote Monitoring with Feedback and Action Plans
The goal of this telehealth intervention is to support patients’ self management by monitoring the symptoms, biometric information and behaviors related to the disease. The data collection can be done by either the patient or caregiver. The information is then shared with the healthcare provider who responds with feedback to the patient. The decisions or actions are undertaken by the patient, with healthcare professional support. These interventions increase patient self-efficacy and accountability.
Another important aspect of this intervention is the written action plan prepared by a healthcare provider. The goal is to allow the patient to remain in control of their condition. The action plan is tailored to the patient, the disease and severity of the illness. Action items in the plan may include: how to take medications, recognize symptoms of deterioration and what to do in “flare-up” situations.
Telehealth-Facilitated Clinical Follow-Up
These are the typical follow-up visits. The goal of this telehealth intervention is to schedule regular visits to review the patient’s concerns and issues, their condition and self-management. The visit is usually performed by a healthcare provider. Scheduling these visits via telehealth increases quality of care and patient satisfaction by facilitating access to care and removing the distance and travel barriers.
Telehealth Intervention for Adherence and Compliance Support
The goal of this telehealth intervention is to support and help improve patients’ compliance and adherence with lifestyle and medication therapy. Medication non-compliance is a pervasive problem that results in poor outcomes and ends up costing our society an estimated in the billions. Actions may include: reminders to take medication as instructed, regular survey and reconciliation of medications, monitoring of medication usage and compliance.
Telehealth Intervention for Psychological Support
The goal of this telehealth intervention is to help people with chronic disease learn skills and strategies to better manage the consequences of their illness (i.e. how to deal with feeling overwhelmed by the disease, or how to reduce the risk for further disease or complications). Actions may include: problem-solving strategies, relaxation techniques, re-framing, distraction, cognitive restructuring, goal setting and action planning.
Telehealth-Facilitated Lifestyle Interventions
The goal of this telehealth intervention is to give advice to the patient with chronic disease around health and lifestyle issues influencing the disease. This is a health-coaching intervention to provide advice and support in relation to handling life stressors. Actions may include general lifestyle advice and support concerning diet, physical activity, smoking cessation, and alcohol intake.
The management of chronic diseases is complex. Therefore the more of these interventions are included in a self-management support program, the more effective it is. However, is not necessary to include all to have an effective program.
The prevalence of chronic diseases continues to increase, placing a burden on both the individuals who suffer from these and on the resources of our nation’s healthcare system. Improving the patient’s ability to self-manage their chronic illness can improve quality of care and outcomes, as well as decrease the costs of care. Healthcare providers can support patients’ self-management by implementing support interventions via telehealth.
If you have any questions or comments about this article, feel free to contact me.
References:
Centers for Disease Control. About Chronic Disease. https://www.cdc.gov/chronicdisease/about/index.htm Last reviewed: October 2019.
New York State Department of Health. Chronic Diseases and Conditions. https://www.health.ny.gov/diseases/chronic/ Last reviewed: November 2019.
Adams K, Greiner AC, Corrigan JM, Eds. The 1st Annual Crossing the Quality Chasm Summit – A Focus on Communities. Washington, D.C: The National Academic Press; 2004. DOI: 10.17226/11085
Pearce G, Parke HL, Pinnock H, et al. The PRISMS taxonomy of self-management support: derivation of a novel taxonomy and initial testing of its utility. J Health Serv Res Policy. 2016;21(2):73-82. DOI: 10.1177/1355819615602725
Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Meta Review of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res. 2017;19(5):e172. DOI: 10.2196/jmir.6688
